Agents Used to Treat Hyperacidity and Gastroesophageal Reflux Disease Chapter 24 Agents Used to Treat Hyperacidity and Gastroesophageal Reflux Disease

Secretory Functions of the Stomach Lining p564 Parietal cells secrete hydrochloric (HCl) acid Chief cells secrete pepsin Mucoid cells secrete mucus Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Stomach Hyperchlorhydria p564 Condition of excess hydrochloric acid Produced from: Eating high-fat meals Increased alcohol intake Emotional turmoil

GERD p564 Gastroesophageal reflux disease Results from regurgitation Leads to inflammation in LES sphincter and esophagus results in If unresolved, esophageal erosion may result

Peptic ulcer disease (PUD) p565 A peptic ulcer is a local lesion of the gastrointestinal lining Duodenal ulcer Gastric ulcer Role of H. pylori

Goal of Antacid Therapy p565 Neutralize the acid General goal of antacid therapy is pain relief

Systemic Antacids p 566 Useful in short-term therapy Rapid onset Prolonged use : overload on the kidneys, acid/base and electrolyte disturbances Example: sodium bicarbonate Cause rebound hyperacidity

Nonsystemic Antacids Table 24-1 pg 567-568 Three Forms of OTC non-systemic antacids Calcium based Aluminum based Magnesium based Mechanism of action Neutralize acid Acid rebound may result from large doses of antacids, particularly Ca+ based antacid

Side Effects Nonsystemic antacids p567-568 Magnesium: diarrhea Aluminum: constipation Calcium: constipation Administration time

Antacid Interactions p566 Binds with drugs Promotes alkalinity of GI tract Avoid simultaneous administration of antacids and antibiotics. Don’t take oral drugs or enteric coated med within 1-2 hours of taking an antacid

Simethicone p566 Simethicone eliminates gas bubbles

Nursing Interventions antacids p572-573 Monitor for side effects Nausea, vomiting, abdominal pain, diarrhea With calcium-containing products: constipation, acid rebound Monitor for therapeutic response Notify heath care provider if symptoms are not relieved.

Histamine H2 receptor antagonists Table 24-2 p569 Action: Inhibit action of histamine at H2 receptor sites of the parietal cells in the stomach Used to treat PUD Side effects: Diarrhea, muscle pain, rash, drowsiness, dizziness, confusion in some patients

Histamine (H2) Receptor Antagonists “H2 blockers” p569 Examples Cimetidine (Tagamet) (prototype) Famotidine (Pepcid) Ranitidine (Zantac)

Cimetidine p569 Contraindicated in nursing mothers or children younger than 16 years Cimetidine: anti-androgenic effects CNS effects Cigarette smoking diminishes the effects of cimetidine. Antacids will reduce the absorption of cimetidine

Proton Pump Inhibitors p570 Action: blocks the final step of acid production in the stomach Result: decreased hydrochloric acid Examples: Omeprazole (Prilosec) Esomeprazole magnesium (Nexium) Indicated for clients with: GERD and esophagitis PUD Interactions Increases effects of warfarin

Proton pump inhibitors cont p570 Side effects: Diarrhea, abdominal pain, nausea Used in combination with clarithromycin and amoxicillin for 14 days for treatment of H. pylori infections

Sucralfate (Carafate) p571 Sucralfate: derivative of sucrose. Sucralfate combines with protein at the ulcer site to form an adherent complex Adverse effects: Nausea, constipation, diarrhea

Nursing considerations for pt with PUD p573 Observe for s/s of complications for PUD Hemorrhage Obstruction Perforation Teach lifestyle behaviors that contribute to PUD Smoking, alcohol, coffee, cola, stress ASA, ibuprofen, naproxen are contraindicated in patients with PUD Protein and calcium in milk are stimulators of hydrochloric acid secretion Teach that ulcer pain often subsides prior to ulcer being healed. Pt to remain on meds until DC by doctor. .

Metoclopramide (Reglan) p571 Prokinetic agent Increases gastric motility Actions: Promotes gastric emptying Increases peristalsis Decreases gastroesophageal reflux Useful in treating diabetic gastroparesis

Metoclopramide (Reglan) p571 Adverse effects Extrapyramidal symptoms Central nervous system depression Gastrointestinal upset Contraindicated in pt with epilepsy or antipsychotic drugs that can cause extrapyramidal symptoms

Gastrointestinal enzymes p572 Pancreatic enzymes Pancrelipase and pancreatin Lactase enzyme For pt who have developed lactose intolerance Symptoms of lactose intolerance Diarrhea, flatulence, bloating with ingestion of dairy products